摘要
目的 探讨集束化护理措施在颅脑术后行机械通气患者排痰中的应用效果.方法 采用便利抽样、非同期对照试验,选取温州医科大学附属第一医院神经外科重症加强治疗病房(ICU)收治的67例颅脑术后机械通气患者,以2015年6月至2016年6月收治的32例患者为对照组,实施呼吸道常规护理;以2016年7月至2017年7月收治的35例患者为干预组,在常规护理基础上实施基于证据的集束化护理干预措施.比较两组患者排痰效果、动脉血气分析指标、肺部感染发生率及预后情况的差异.结果 与对照组比较,干预组排痰量明显增多(mL/d:49.69±9.45比33.72±10.63,P<0.05),每日吸痰次数(次:21.57±2.31比28.76±22.66)、每次吸痰所需时间(s:6.81±1.74比9.28±2.52)、呼吸频率(次/min:26.26±1.83比28.58±1.36)、肺部感染发生率〔0比12.5%(4/32)〕、机械通气时间(d:6.37±2.51比8.92±3.32)、入住ICU时间(d:7.49±3.87比10.33±2.12)、总住院时间(d:10.31±1.99比14.56±3.57)、病死率〔8.6%(3/35)比21.9%(7/32)〕均明显减少(均P<0.05);两组治疗后动脉血氧分压(PaO2)、脉搏血氧饱和度(SpO2)均较治疗前明显明显增加,动脉血二氧化碳分压(PaCO2)较治疗前明显减少,且干预组治疗后5 d的改善程度明显优于对照组〔PaO2(mmHg, 1 mmHg=0.133 kPa):60.89±3.44比57.34±2.49,PaCO(2mmHg):41.06±4.32比45.22±4.78,SpO2:0.986±0.030比0.963±0.023,均P<0.05〕.结论 集束化护理措施可有效改善颅脑术后机械通气患者的排痰效果,并降低肺部感染发生率和病死率,减少入住ICU时间,改善患者预后,值得在临床推广运用.
Objective To explore the effect of using cluster nursing measures on expectoration in mechanical ventilation patients after craniocerebral operation. Methods Convenient sampling and controlled trials at not the same period were used. Sixty-seven mechanical ventilation patients after craniocerebral operation were selected as the research objects in Department of Neurosurgery Intensive Care Unit (ICU) of the First Hospital Affiliated to Wenzhou Medical College. Thirty-two patients treated from June 2015 to June 2016 were assigned in the control group, and they were given routine respiratory nursing care; 35 patients admitted and treated from July 2006 to July 2017 were included in the intervention group, and they were given evidence-based cluster nursing intervention measures on the basis of routine care. The differences in expectoration effect, arterial blood gas analysis index, incidence of pulmonary infection and prognosis of patients in two groups were compared. Results Compared with control group, the amount of expectoration in the intervention group was significantly increased (mL/d: 49.69±9.45 vs. 33.72±10.63, P < 0.05), while the daily number of sputum suction (times: 21.57±2.31 vs. 28.76±22.66), the time needed for each sputum suction(s: 6.81±1.74 vs. 9.28±2.52), respiratory frequency (bpm: 26.26±1.83 vs. 28.58±1.36), incidence of pulmonary infection [0 vs. 12.5% (4/32)], time of mechanical ventilation (days: 6.37±2.51 vs. 8.92±3.32), time of ICU stay (days: 7.49±3.87 vs. 10.33±2.12), time of hospital stay (days: 10.31±1.99 vs. 14.56±3.57), fatality rate [8.6% (3/35) vs. 21.9% (7/32)] in the intervention group were significantly decreased (all P < 0.05); after treatment the arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation degree (SpO2) were significantly increased than those before treatment, and the arterial partial pressure of carbon dioxide (PaCO2) was significantly decreased than that before treatment, and the degrees of improvement in the intervention group on 5 day
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第2期194-200,共7页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省自然科学基金(LY16H160051) Natural Science Foundation of Zhejiang Province (LY16H160051)
关键词
集束化护理
颅脑术后
机械通气
排痰效果
Cluster nursing
Craniocerebral post-operation
Mechanical ventilation
Expectoration
